PrescQIPP

Viaduct Care comprehensive, system-wide initiative to improve the safety and effectiveness of gabapentinoid prescribing across Stockport (2025)

Viaduct CIC Stockport integrated Pharmacy Service

Project summary

Viaduct Care led a comprehensive, system-wide initiative to improve the safety and effectiveness of gabapentinoid prescribing across Stockport. The project focused on patients with impaired renal function—defined as <60 ml/min for pregabalin and <80 ml/min for gabapentin—who are at increased risk of adverse effects. The initiative aligned with Greater Manchester-wide guidelines, including the Opioid Resource Pack, Neuropathic Pain Guidance, and Gabapentinoid Resource Pack, and promoted multilingual, multi-format educational resources for both patients and healthcare professionals.

Aims and Objectives

  • Identify and prioritise patients on gabapentinoids with renal impairment.
  • Optimise prescribing in line with regional safety and pain management guidelines.
  • Support deprescribing of medications with dependence potential.
  • Empower practitioners through education, peer support, and standardised processes.
  • Provide holistic, biopsychosocial support to patients undergoing medication changes.

Key Interventions

1. Patient Identification and Risk Stratification

  • Real-time data analysis was used to identify patients prescribed gabapentinoids and stratify them based on renal function.
  • Patients with impaired renal function were flagged for urgent review due to increased safety risks.

2. Medication Review and Optimisation

  • Pharmacists and GPs conducted thorough medication reviews to assess the risk posed by gabapentinoids, particularly in those with compromised renal function.
  • Patients at risk were supported in reducing their gabapentinoid doses, ensuring that medication management was aligned with their health needs, dose appropriateness and potential for deprescribing.
  • Patients were supported through gradual dose reductions or desensitisation protocols, with close monitoring.

3. Biopsychosocial Patient Support

The Viaduct Wellbeing Team (social practitioners, care coordinators) and First Contact Practitioners (FCPs) provided wraparound support.

FCP could support patients with musculoskeletal issues such as back, neck and joint pain by assessing and diagnosing issues, giving expert advice on how best to manage their conditions or referring them onto specialist services if necessary.

The Viaduct Care Wellbeing Team and First Contact Practitioners (FCP) across Stockport were involved in offering support for any new pain or mental health concerns resulting from the medication changes. The wellbeing team comprising social practitioners, Care Coordinators, were able to support the patients to identify what local services might be able to address wider social determinants of health.

4. Practitioner Empowerment and Training

It was recognized that deprescribing medications, especially those at risk of dependence such as gabapentinoids, presents significant challenges. Healthcare practitioners often feel apprehensive about reducing or discontinuing these medications due to concerns about patient reactions or potential withdrawal symptoms. Viaduct Care aimed to support these practitioners, providing them with the tools, guidance, and reassurance necessary to ensure they felt confident in delivering high-quality patient care during the prescribing process

  • Each practice appointed an Opioid Champion to lead on safe prescribing.
  • A Standard Operating Procedure (SOP) was developed to standardise the approach across practices.
  • A web-based platform enabled patient engagement via educational texts, videos, and self-booking links.
  • Pain review and opioid risk assessment templates were introduced to improve documentation quality.
  • Targeted training sessions were delivered, featuring speakers from local hospital pain teams, FCPs, and wellbeing teams.
    Outcomes and Impact
  • Significant reduction in gabapentinoid prescribing, particularly among high-risk patients with renal impairment.
  • Improved patient safety, with fewer adverse effects and better-aligned prescribing practices.
  • Enhanced practitioner confidence, supported by peer mentorship, SOPs, and real-time data feedback.
  • Outperformed regional and national benchmarks, achieving greater reductions in prescribing rates than both Greater Manchester and England overall.
    Lessons Learned
  • Early and consistent engagement from practices and Primary Care Networks (PCNs) led to better outcomes.
  • Peer networking and mentorship were critical in building practitioner confidence.
  • Some patient resistance was encountered; this was mitigated through GP support and high-quality, accessible patient education.

Best Practice Principles for Future Expansion

  1. Well-trained practitioners supported by clear SOPs and ongoing education.
  2. Data-driven patient identification and risk stratification to target interventions effectively.
  3. Accessible, multi-format patient education to support understanding and engagement.
  4. Integrated biopsychosocial support, addressing physical, mental, and social health needs.